Laparoscopic suturing devices, needles, sutures, and drive systems

ABSTRACT

Devices are provided for a suturing device used during laparoscopic surgical procedures. A suturing needle includes a shaft forming a rod axis; a curved body having a piercing tip at a first end and a base at a second end; and an arm extending radially from the shaft to the base of the curved body such that the curved body is positioned in a plane orthogonal to the rod axis of the shaft and rotatable about the shaft in the plane orthogonal to the rod axis. The suturing device includes a housing, a suturing needle, one or more sutures, a suture magazine configured to hold the one or more sutures, and a drive system, whereby the drive system may actuate the suturing needle to rotate in the plane orthogonal to the drive system, allowing the suturing needle to drive in to and out of tissue to apply a suture.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of prior, co-pending U.S. applicationSer. No. 15/792,749, filed on Oct. 24, 2017, which claims priority toU.S. Provisional Application No. 62/411,830, filed on Oct. 24, 2016,both of which are incorporated herein by reference in their entirety forall purposes.

BACKGROUND

Laparoscopic surgical procedures are becoming increasingly common as analternative to open surgical procedures. Pain, hemorrhaging, andrecovery time may be reduced when performing a laparoscopic surgicalprocedure versus an open surgical procedure. However, laparoscopicprocedures can take longer to perform, which can increase the cost ofperforming the laparoscopic procedure and limit the amount oflaparoscopic procedures that can be performed daily.

Suturing is a common method employed in surgeries to close tissueopenings and secure synthetic objects to tissue, among other things. Thesuturing process is more challenging when being used in laparoscopicsurgical procedures as there is a smaller space to work within and thedegrees of movement that a surgeon is afforded is restricted as comparedto open surgical procedures.

BRIEF SUMMARY

The following summary is provided to introduce a selection of conceptsin a simplified form that are further described below in the detaileddescription. This summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tobe used to limit the scope of the claimed subject matter.

A suturing needle is provided that has a shaft forming a rod axis, acurved body having a piercing tip at one end and a base at another end;and an arm extending radially from the shaft to the base of the curvedbody such that the curved body is positioned in a plane orthogonal tothe rod axis of the shaft and rotatable about the shaft in the planeorthogonal to the rod axis.

A suturing device incorporating the above described suturing needle caninclude one or more sutures, and a drive system. The drive system iscoupled to the shaft and configured to actuate the rotation of thesuturing needle in a first direction into tissue and a second directionthat is opposite the first direction. The one or more sutures eachinclude a fastener end, an anchor end, and a suture thread extendingbetween the fastener end and the anchor end. A suture magazine can beused to hold the one or more sutures. The suturing needle and the suturemagazine are positioned within a housing that allows for the suturingneedle to exit the housing, catching the suture at the fastener end, asthe suturing needle rotates in the first direction in the planeorthogonal to the rod axis.

A drive system for a suturing device can include a tube having aproximal end that may abut a hub that couples to a manual or roboticarm, a distal end that couples to a shaft of a suturing needle, and arod having the hub at its distal end and one more protrusions on the rodin a position towards the proximal end of the rod and one or moregrooves, each groove being for a corresponding one of the oneprotrusions, the one or more grooves extending in a spiral manner from aproximal end of the tube towards the distal end of the tube. The one ormore protrusions on the rod are configured to move along the one or moregrooves of the tube. The rod is configured to remain fixed along adirection of a tube axis of the shaft while being able to rotate aboutthe tube axis. The tube is configured to remain fixed in a radialdirection while being moveable forward and backward along the tube axis,the moving of the tube in the forward and backward direction causing theone or more protrusions of the rod to move along the one or more groovesand thereby rotate the rod and the shaft that would be coupled theretoabout the tube axis. In another implementation, the protrusions may bein the tube and the grooves on the rod.

These and other features and advantages will be apparent from a readingof the following detail description, and a review of the appendeddrawings. It is to be understood that the foregoing summary, thefollowing detail descriptions, and the appended drawings are onlyexplanatory and are not restrictive of various aspects claimed.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1A shows a suturing needle in accordance with an implementation ofthe invention.

FIG. 1B shows an alternative suturing needle in accordance with animplementation of the invention.

FIG. 1C shows a cross sectional view of a suturing device in a startposition in accordance with an implementation of the invention.

FIG. 2A shows a suture in accordance with an implementation of theinvention.

FIGS. 2B-2C show side views of a fastener end according to animplementation of the invention.

FIGS. 3A-3E show views of a suturing device and housing in accordancewith an implementation of the invention. FIG. 3A shows a view of asuturing device over tissue in a middle position; FIG. 3B shows a viewof a suturing device over tissue in an end position; FIG. 3C shows across-sectional view of a suturing device over tissue in an endposition; FIG. 3D shows a view of a suture housing that is filled withsutures; FIG. 3E shows a view of an empty suture housing.

FIG. 4 shows a suturing device including a trigger according to animplementation of the invention.

FIGS. 5A-5B show bottom views of a suturing device with sutures inaccordance with an implementation of the invention.

FIG. 6A shows a suture magazine and its various components, including aneedle housing, in accordance with an implementation of the invention.

FIG. 6B shows a suture magazine positioned inside the housing of asuturing device according to an implementation of the invention.

FIGS. 7A-7D shows an automatic suture tightening technique in accordancewith an implementation of the invention.

FIG. 8 shows a manual suture tightening technique in accordance with animplementation of the invention.

FIG. 9A shows a side view of a drive system in accordance with animplementation of the invention.

FIG. 9B shows a side view of an exploded view of a drive system inaccordance with an implementation of the invention.

FIGS. 9C-9D show a view of a drive system attached to handles in theopen and closed positions in accordance with an implementation of theinvention.

FIG. 9E shows the grasping clamp and the suturing device apart and inthe end position.

FIG. 9F shows the suturing device in the start position.

FIG. 10 shows a side view of an alternative drive system in accordancewith an implementation of the invention.

DETAILED DESCRIPTION

Implementations of the invention provide devices to improve suturingtechniques in laparoscopic surgical procedures. Certain implementationsof the invention enable surgeons to perform suturing procedures moreefficiently even with the challenges presented by the restrictedmovement inherent in laparoscopic procedures.

Laparoscopic procedures can be performed manually or with arobotic-assisted surgical system. Manual laparoscopic surgicalprocedures involve cutting small incisions into the patient and placingtubes called ports through the incision site. The ports can includesurgical instruments such as forceps, hooks, scissors, and more to mimicthe movement and ability of the surgeon's hands. This allows the surgeonto perform the entire surgery ex vivo without physically placing theirhands into the patient's body.

Alternatively, robotic-assisted laparoscopic procedures use arobotic-assisted surgical system that generally includes three or fourrobotic arms that the surgeon can manipulate from a distance at aconsole. Similar to the ports used in manual laparoscopic surgicalprocedures, at the console, the surgeon operates haptic controls thatmimic the movement and ability of the surgeon's hands. With both manuallaparoscopic procedures and robotic-assisted laparoscopic procedures,the surgeon must use instruments rather than their own hands to interactwith tissue, making it difficult to reproduce functions that wouldnormally be performed with a human hand. As a result, applying suturesto tissue during laparoscopic surgical procedures have become morecumbersome and tedious resulting in longer surgery times.

In particular, laparoscopic sacrocolpopexy, a surgical procedure used totreat vaginal vault or uterine prolapse, is susceptible to thechallenges that current laparoscopic procedures present. A uterineprolapse results when the uterus descends from its normal positionwithin the pelvis. Every year in the United States, approximately300,000 women participate in pelvic organ prolapse corrective surgery.Sacrocolpopexy is a surgical technique that aims to reduce prolapse andrestore the anatomy and function of the vagina by suturing a syntheticmesh to the vaginal wall. The mesh provides the vagina with support andrequires about 12-15 sutures. Overall, the procedure can take three tofour hours to complete, where the suturing process alone may require 60to 100 minutes.

In order to address these challenges, certain implementations provide anefficient suturing device that, with a single motion, can stitch andtighten a suture, which diminishes the time, cost, and difficulty oflaparoscopic surgeries.

Certain implementations involve automated stitching and tightening ofsutures.

As used herein, the term “distal” end generally refers to the end thatis further from the surgeon when the surgeon is operating the device.

Additionally, the term “proximal” end generally refers to the end thatis closer to the surgeon when the surgeon is operating the device.

FIGS. 1A, 1B, and 1C show a suturing needle 100 that can be used in asuturing device (explained in further detail below with respect to FIGS.3A-3E). The suturing needle 100 has a curved body 101, an arm 102, and ashaft 103. The curved body 101 may have a piercing tip 104 at one endand a base 106 at the other end. The shaft 103 can form a rod axis 107.In one implementation, the suturing needle 100 may have a needlegrasping edge 105 that is formed by the tube of the curved body 101having a larger diameter than the base of the piercing tip 104. Thisallows the suture to be held along the needle grasping edge 105 as thecurved body 101 rotates about the shaft 103. In an alternateimplementation, the suturing needle 100 may also have a grasping element112 that is configured to form a recess between the grasping element 112and the piercing tip 111 so that a suture may be held in the recess asthe curved body 101 rotates about the shaft 103. In anotherimplementation, the needle may include a groove 113 extending from thepiercing tip 104 along at least a portion of an outer surface of thecurved body 101. The groove 113 can be configured to maintain a fastenerportion of a suture in a position along the outer surface of the curvedbody 101 of the suturing needle 100.

The arm 102 extends radially from the shaft 103. The curved body 101 ispositioned in a plane orthogonal to the rod axis 107 of the shaft 103and rotatable about the shaft 103 in the plane orthogonal to the rodaxis 107 to drive in to and out of a tissue 108 to apply a suture 200(described in more detail below).

FIG. 2A illustrates an implementation of a suture 200 that may be usedwith a suturing device. A suture 200 can include a fastener end 201, ananchor end 202, and a suture thread 203 connected to and extendingbetween the fastener end 201 and the anchor end 202. The fastener end201 and the anchor end 202 may be made of polydllactide (PDLLA) oranother biodegradable material. The suture thread 203 may be made ofbiodegradable material such as polydioxanone (PDS), polypropylene, orthe like.

The suture 200 can include a first fastener mechanism 204 and a secondfastener mechanism 205. Referring to FIG. 1 and FIGS. 2A-2C, as thesuturing needle 100 rotates about the shaft 103, the piercing tip 104 isinserted through the first fastener mechanism 204. As the suturingneedle 100 continues rotation, the needle grasping edge 105 secures thefirst fastener mechanism 204 and pulls it through the tissue 108 andthrough the chamber 206 of the anchor end 202 of the suture 200. Thefirst fastener mechanism 204 can then be used to pull the secondfastener mechanism 205 through the chamber 206 to tighten the suture 200to pull the tissue 108 together.

In this implementation, as the first fastener mechanism 204 is movedthrough the chamber 206 (see FIG. 2C) of anchor housing 207 of theanchor end 202, the geometrical configuration locks the fastenergrasping edge 208A of the first fastener mechanism 204 on top of thechamber 206 such that the first fastener mechanism 204 cannot be movedbackwards through the chamber 206.

Referring to FIG. 2A, the fastener end 201 has a top 209 and a bottom210. The suture thread 203 may be embedded in, molded in, or otherwisefixed to the top 209 of the fastener end 201. The bottom of the fastenerend 201 may include a suture guide loop that performs part of thefunction of the first fastener mechanism, meaning that the suture guideloop can be secured by the grasping element 112 or other functionallysimilar structure and moved through the tissue 108 and into or throughthe anchor end 202 of the suture 200.

Referring now to FIG. 2C, the chamber 206 is contained within the anchorhousing 207. The chamber 206 may have a conical shape. However, theshape of the chamber 206 and even the anchor end 202 can vary. Forexample, the chamber may be rectangular, curved, semi-spherical, or anyother known shape that can function to receive the fastener end 201 ofthe suture 200 and secure the fastener end 201 to the anchor end 202. Inan alternate embodiment, the suture thread 203 may be looped through thechamber 206 and tied around the anchor housing 207, and extend andconnect to the fastener end 201. In another implementation, the suturethread 203 may be embedded in, molded in, or otherwise fixed to theanchor housing 207 of the anchor end 202.

When the first fastener mechanism 204 of the fastener end 201 passesthrough the chamber 206 in an upward direction, the conical shape of thechamber 206 receives the first fastener mechanism 204 and locks thefirst fastener mechanism 204 over the top of the chamber 206. Thisinhibits the fastener end 201 from returning backwards through thechamber 206.

It should be understood that the fastener end 201 and the anchor end 202may utilize any known geometrical configurations and/or lockingmechanisms and are not limited to any one particular configuration. Forexample, the fastener end may have one or more ridges, the ridges beingsimilar to a barb on a fish hook. These ridges may be designed to lockinto a chamber of the anchor end. The chamber can have a structure tofacilitate the locking of the fastener end into the anchor end, such asa curved shoulder to allow for the ridges to enter the chamber, but notallowing the ridges to exit the chamber in the direction that the ridgesentered into the chamber. Of course, the shape of the fastener end canvary and is not limited to having a surface with one or more ridges. Forexample, in another alternate implementation of the fastener end, thefastener end may have a flat surface and a surface with one or moreridges opposite from the flat surface.

The chamber may have one or more shoulders configured to allow thefastener end to enter the chamber in a unidirectional manner.

When the fastener end passes through the chamber in an upward direction,the ridges of the fastener end pass the shoulders. The ridges lay on topof the shoulders to inhibit the fastener end from moving in a downwarddirection. This inhibits the fastener end from escaping the chamber andsecures the fastener end inside the anchor end. As stated above, theshape of the fastener end and the anchor end are not limited to theimplementations previously stated, and various other shapes andconfigurations may be used to secure the fastener end to the anchor end.

FIGS. 3A-3E show views of a suturing device and housing in accordancewith an implementation of the invention. FIG. 3A shows a view of asuturing device over tissue in a middle position; FIG. 3B shows a viewof a suturing device over tissue in an end position; FIG. 3C shows across-sectional view of a suturing device over tissue in an endposition; FIG. 3D shows a view of a suture housing that is filled withsutures; FIG. 3E shows a view of an empty suture housing. As illustratedin FIGS. 3A-3E, a suturing device 300, in accordance with variousimplementations of the invention includes a suture housing 301, asuturing needle 302, one or more sutures 304, a suture magazine 303configured to hold the one or more sutures 304, and a drive system 305configured to actuate the rotation of the suturing needle 302 in a firstdirection into a tissue 310 and a second direction that is opposite thefirst direction to apply one or more sutures 304 to the tissue 310, orto apply one or more sutures 304 to mount an implant (e.g., syntheticmesh) onto the tissue 310.

FIG. 4 illustrates a laparoscope with suturing device. A laparoscopewith suturing device 400 can be implemented, for example, with suturingdevice 300 mounted at a distal end of a standard laparoscope. Thelaparoscope may include a stem 402 and a trigger (not shown). The stem402 of the laparoscope has a length long enough to allow the surgeon tooperate the suturing device (e.g., device 300) from a location outsideof the patient while the suturing device is in contact with tissue. Thestem 402 is coupled to a drive system, for example, drive system 305, ofthe suturing device via clamps 404. The trigger (not shown) is locatedat the proximal end of the laparoscope. The surgeon can squeeze thetrigger (not shown) to apply a force to the drive system 305 (via clamps404), and thus engage the suturing device 300 to apply a suture.

In another implementation, the suturing device 300 may be mounted to thedistal end of a robotic-assisted surgical forceps arm. A sheath made ofa non-ridged sterile material may be used to connect the proximal end ofthe suture housing 301 to the distal end of the robotic-assistedsurgical forceps arm. The sheath allows flexibility in orienting thesuturing device 300 in different directions. The surgeon can close theforceps on the robotic-assisted surgical forceps arm to apply a force tothe drive system 305, and thus engage the suturing device 300 to apply asuture 304. Alternatively, the suturing device 300 may be actuated as arobotic arm that works in tandem with a robotic-assisted surgicalsystem. The surgeon can operate the suturing device 300 at a console toadminister sutures 304.

Referring back to FIGS. 3A and 3B, the suture housing 301 of thesuturing device 300 encloses the suturing needle 302, the one or moresutures 304, the suture magazine 303 configured to hold the one or moresutures 304, and the drive system 305. The suturing needle 302 can havea shaft 311 forming a rod axis 107, a curved body 306 having a piercingtip 308 at one end and a base 312 at another end, and an arm 307extending radially from the shaft 311 to the base 312 of the curved body306 so that the curved body 306 is positioned in a plane orthogonal tothe rod axis 107 of the shaft 311 and rotatable about the shaft 311 inthe plane orthogonal to the rod axis 107. The suturing needle 302 mayalso be designed in accordance with the suturing needle 100 or 110 asdescribed in FIGS. 1A, 1B, and 1C.

The one or more sutures 304 of the suturing device 300 each comprises afastener end, an anchor end, and a suture thread extending between thefastener end and the anchor end. The one or more suture may be designedin accordance with the suture illustrated in FIG. 2A. Additionally, thefastener end and the anchor end may be designed as described withrespect to the fastener end illustrated in FIG. 2A, and the anchor endillustrated in FIGS. 2A, 2B, and 2C.

Referring now to FIGS. 5A and 5B, the suture housing 301 of the suturingdevice 300 has an aperture in the plane orthogonal to the rod axis ofthe suturing needle 302 that permits exiting of the suturing needle 302and one of the one or more sutures 304 from the suture housing 301. Thesuture housing 301 may have a curved upper interior surface and a flatlower interior surface, where the aperture is in the flat lower interiorsurface. The curved upper interior surface of the suture housing 301 isslightly longer than the flat interior lower surface to allow thesuturing needle 302 to rotate in to and out of the tissue 310 to apply asuture 304 (see FIGS. 3A, 3B, and 3C). However, the shape of the suturehousing 301 can vary and is not limited to having a curved upperinterior surface and a flat lower interior surface. In oneimplementation, the curved upper interior surface of the suture housing301 may have a needle track that maintains the suturing needle 302within the plane orthogonal to the rod axis of the suturing needle 302.

The suture housing 301 may be made of a rigid sterile material, and thesuture housing 301 may be discarded after use, or sterilized and re-usedfor numerous procedures. Additionally, in one implementation, the suturemagazine 303 may be discarded after use, and may be replaced withanother suture magazine 303. The suture magazine 303 is configured tohold the one or more sutures 304 within the suture housing 301 so thatthe fastener end 201 of the one or more sutures 304 can be positioned tobe grasped by one end of the curved body 101 of the suturing needle 302as it exits the aperture in the suture housing 301 at one side of theshaft 103 of the suturing need 302, and the anchor end 202 can bepositioned to exit the aperture in the suture housing 301 at anotherside of the shaft 103 of the suturing needle 302. The suture magazine303 is seated on to the flat lower surface of the suture housing 301towards the distal end of the suturing device 300.

FIG. 6A illustrates an implementation of a suture magazine 600 that maybe used in the suturing device 300 as shown in FIG. 3A. Each suture canhave a fastener end 602, an anchor end 603, and a suture thread 604connected to and extending between the fastener end 602 and the anchorend 603. The suture thread 604 may be made of biodegradable materialsuch as polydioxanone (PDS), polypropylene, or the like. In oneimplementation, the suture may be designed in accordance with the sutureillustrated in FIG. 2A. Additionally, the fastener end 602 and theanchor end 603 may be designed in accordance with the fastener end 201illustrated in FIG. 2A and the anchor end 202 illustrated in FIGS. 2Band 2C. The suture magazine 600 can include elastic members 601. Theelastic members 601 can be made of rubber or another elastic material.The elastic members 601 have a distal end that is towards the sutureneedle 100 and a proximal end that is towards the hub. The distal end ofthe elastic members 601 is attached to the suture housing cover 605 andthe proximal end is attached to the suture movers 606. The suture movers606 are configured to slide within the suture magazine 600 such thatwhen a suture is used and leaves through the aperture in the suturehousing 301, the force created by the elastic members 601 pulls thesuture movers 606 forward which in turn pushes any remaining suturesforward towards the distal end of the suturing device 300. In analternate embodiment, a spring can be placed on the proximal end(behind) of the suture movers 606 so that the sutures can be movedforward when a suture is used and leaves through the aperture in thesuture housing 301. The spring can be used as a replacement to or incombination with the elastic members 601 to move the sutures forwardeach time a suture is used and leaves through the aperture in the suturehousing 301. The spring/suture movers combination or the elasticmembers/suture movers combination may be used as a loading mechanism incontact with the suture magazine 600. The loading mechanism is notlimited to these combinations. The loading mechanism may be anystructure that can be tensioned to apply a force to the suture magazine600.

FIG. 6B shows the suture magazine 600 positioned inside the suturehousing 301 of the suturing device 300. When the suture magazine 600 isseated on to the flat lower interior surface of the suture housing 301,the suture thread 604 lays laterally behind the suturing needle 302 andacross the flat lower interior surface of the suture housing 301. Thesuturing needle 302 can be actuated to rotate in the plane orthogonal tothe tissue to drive in to and out of the tissue to apply a suture.

The suturing needle 302 has a curved body 306, an arm 307, and a shaft311. The curved body 306 may have a piercing tip 308 at one end and abase 312 at the other end. The shaft 311 can form a rod axis. In oneimplementation, the suturing needle 302 may also have a grasping edge309 that is configured to form an edge between the grasping edge 309 andthe piercing tip 308. This allows for the piercing tip 308 to enter thetissue in a curved motion with the first fastener mechanism 313 in tow,and exit the tissue while simultaneously inserting the first fastenermechanism 313 through the chamber 314 or the anchor housing 315.

In an alternate embodiment, the needle may also include a groove 113extending from the piercing tip 111 along at least a portion of an outersurface of the curved body 306. The groove 113 can be configured tomaintain the fastener end 602 in a position along the outer surface ofthe curved body 306 of the suturing needle 302. In anotherimplementation, the fastener end 602 can include a suture guide loop,and the grasping element 312 of the suturing needle 302 may grab thesuture guide loop to pull the fastener end 602 from the belt and enterthe tissue in a curved motion with the fastener end 602 in tow, and exittissue while simultaneously inserting the fastener end 602 into theanchor end 603.

In one implementation, the suturing needle 302 can be actuated by thedrive system 305. The drive system 305 is coupled to the shaft 311 ofthe suturing needle 302, whereby the curved body 306 is positioned in aplane orthogonal to drive system 305. The suturing needle 302 can rotatein a first direction and a second direction that is opposite the firstdirection, in the plane orthogonal to tissue from a starting position toan end position. In the starting position (see FIG. 1B), the curved body306 of the suturing needle 302 is stationary inside the suture housing301 in the plane orthogonal to the drive system 305, the fastener end602 of the suture is in place for grasping by the suturing needle 302,and the anchor end 603 of that suture is positioned away from theaperture in the suture housing 301. In a motion to the end position, theneedle 302 rotates in the first direction from the starting position,grasps the fastener end 602 while the anchor end 603 is moved intoposition over the aperture in the suture housing 301, and continues torotate into tissue in a curved path on a plane orthogonal to tissue,inserting the fastener end 602 into the anchor end 603. At the endposition (see FIGS. 3A and 3C), the suturing needle 302 automaticallyrotates in the second direction to return to the starting position. Asthe suturing needle 302 returns to the starting position, the arm 307 ofthe suturing needle 302 comes into contact with the anchor end 603. Theanchor end 603 is pushed out of the aperture in the suture housing 301by the arm 307 of the suturing needle 302, allowing a next suture tohave its fastener end 602 to move into position for grasping by thesuturing needle 302. The fastener end 602 is released from the suturemagazine 600 as the suture needle 302 and grasping edge 309 grasp thefastener end 602 and drag the fastener end 602 along a curved path to beinserted through the anchor end 603. The elastic members 601 apply apulling force to the suture movers 606 which in turn apply a pushingforce to the fastener end 602 and the anchor end 603, allowing anotherfastener end 602 and anchor end 603 to move into position to be grappledby the needle 302. When the fastener end 602 is inserted into the anchorend 603, the fastener end 602 is configured to be pulled through orlocked within the anchor end 603 upon insertion to retain the sutureunder tension.

In an implementation incorporating a spring, after the fastener end 602is released from the notch of the belt as the suturing needle 302 graspsthe fastener end 602 and drags the fastener end 602 along a curved pathto be inserted into the anchor end 603, the spring applies a pushingforce to the anchor end 603 that urges the belt and the anchor end 603forward, allowing another fastener end 602 to move into position to begrappled by the needle 302. When the fastener end 602 is inserted intothe anchor end 603, the fastener end 602 is configured to lock with theanchor end 603 upon insertion to retain the suture under tension.

In an alternate embodiment, a suture magazine can include a belt havingone or more notches, and at least one suture. The belt is positionedparallel to the anchor end 603. The belt may be made of rubber oranother elastic material. The fastener end 602 is releasably secured tothe notch of the belt. In one implementation, a crossbar can be attachedto the belt. The crossbar has a first end and a second end. The firstend is fixed to the belt, and the second end is in contact with theanchor end 603. A spring may be located behind the crossbar andpositioned behind the anchor end 603.

FIGS. 7A-7D show an automatic suture tightening technique. In FIG. 7A, asuture 700 is shown in a starting position over top of tissue 710. Next,as shown in FIG. 7B, the first fastener mechanism 704 of the fastenerend 701 is inserted through an entry point of the tissue 710 and carriedthrough the tissue 710 along a curved path by a suturing needle. In thisembodiment, the suturing needle pushes the first fastener mechanism 704along the fastener grasping edge 708A. As the suturing needle continuesalong the curved path and reaches an ending position, as shown in FIG.7C, the first fastener mechanism 704 is pushed through the chamber 706of the anchor end 702. The suture thread 703 pulls the second fastenermechanism 705 through the tissue 710 along the same curved path as firstfastener mechanism 704. As the suture 700 is released from the suturingdevice, the fastener grasping edge 708A can rest on top of the anchorhousing 707. At this stage, there is no tension on the suture thread703. As shown in FIG. 7D, after the first fastener mechanism 704 ispulled in an upward direction, the second fastener mechanism 705 ispulled through the chamber 706 of the anchor end 702 and causes thetissue 710 to be pulled together. The suture 700 is designed so thatwhen the second fastener mechanism 704 is pulled through the chamber 706of the anchor end 702, a predetermined tension is created throughout thesuture thread 703. At this point, the fastener grasping edge 708Bprevents the second fastener mechanism 705 from moving backward throughthe chamber 706 of the anchor end 702.

In another implementation, as shown in FIG. 8, in accordance with animplementation of a suture as described with respect to FIG. 4, thesurgeon may manually grasp the first fastener mechanism 704 with aseparate laparoscopic instrument and pull the first fastener mechanism704 upward to tighten the suture thread 703 until the second fastenermechanism 705 is pulled through the chamber 706 to provide the desiredtension on the suture. In another implementation, the surgeon maymanually grasp the suture guide loop with a separate laparoscopicinstrument and pull the suture guide loop upward to tighten the suturethread 703. Alternatively, the suturing device may have a hookpositioned on the exterior of the suture housing, and the surgeon maymanually tighten the suture using the hook rather than using anadditional laparoscopic instrument.

As shown in FIG. 8, as the base 709 and the arm 710 return to thestarting position, the base 709 pushes the anchor end 702 through thesuture housing aperture 711, allowing the next fastener end 701 to bemoved into position by the elastic member 601 and the suture mover 606(not shown in this figure).

In another implementation, the suture housing of the suturing device 300may have a clamp positioned along the interior surface of the suturehousing that grasps the suture guide loop as the fastener end 702 entersthe anchor end 703. As the suturing device is pulled away from tissue,the suture is tightened, and the clamp releases the suture guide looponce the suture reaches a predetermined tension. In an alternateembodiment, the clamp can grasp the suture guide loop as the fastenerend 702 enters the anchor end 703.

In another implementation, the suture housing may have a catch attachedto the interior surface of the suture housing to a side of the aperture,as described with respect to FIG. 5B. The catch can releasably grasp thesuture guide loop of the fastener end 702 as the arm 710 of the suturingneedle pushes down on the anchor end 703 when returning to the startingposition. The catch automatically releasing the suture guide loop oncethe suture reaches a predetermined tension. Alternatively, the catch canreleasably grasp the suture guide loop as the suturing device is pulledaway from tissue and the catch automatically releasing the suture guideloop once the suture reaches a predetermined tension. In an alternateembodiment, the catch can be adapted to perform the same functions witha fastener mechanism that is described above with respect to a sutureguide loop.

FIGS. 9A-9F show a drive system 900 that can be used to operate thesuturing device 300 (see FIGS. 3A-3C). The drive system 900 includes atube 901 and a rod 902. The diameter of the rod 902 is smaller than thediameter of the tube 901. The rod 902 may include one or moreprotrusions 903 positioned on the exterior surface of the rod 902towards the proximal end. The tube 901 may have one or more grooves 904that extend in a spiral manner from a proximal end of the tube 901towards the distal end of the tube 901. Each groove 904 can correspondto one of the one or more protrusions 903. The one or more protrusions903 attached to the rod 902 are configured to move along the one or moregrooves 904 within the tube 901.

In one implementation, the proximal end of the rod 902 may abut a hub905, and the distal end of the rod 902 is coupled to a shaft 311 of asuturing needle. The shaft can in the tube 901 and the rod 902. The tube901 can have the hub 905 positioned at the proximal end of the tube 901.The rod 902 is configured to remain fixed along a direction of a rodaxis of the shaft while being able to rotate about the rod axis. Thetube 901 is configured to remain fixed in a radial direction while beingmovable forward and backward along the rod axis.

In a starting position, the rod 902 is positioned inside the tube 901,where the protrusions 903 lay on the grooves 904 of the tube 901, andthe hub 905 of the tube 901 meets the proximal end of the rod 902. As aforce pushes on the hub 905, the grooves 904 engage the protrusions 903of the rod 902 and the tube 901 drives along the rod 902 from theproximal end of the rod 902 to the distal end of the rod 902, therebyrotating the rod 902 forward as the protrusions 903 travel along thegrooves 904 of the tube 901. Once the force is withdrawn from theproximal end of the tube 901, the tube 901 reverses direction from thedistal end of the rod 902 to the proximal end of the rod 902, therebyrotating the rod 902 backward as the protrusions 903 travel along thegrooves 904 in the opposite direction.

In order to connect the drive system 900 to a surgical device, such as alaparoscopic device, the distal end of the hub handles 906 are attachedto the hub 905. At the proximal end of the hub handles 906, clamp headreceiving members 907 are attached to receive a grasping clamp 909 froma surgical device. Clips 908 are positioned around the clamp headreceiving members 907 and the grasping clamp 909 so that the clamp headreceiving members 907 and the grasping clamp 909 are secured to oneanother.

In one implementation, the rod 902 of the suturing needle 302, asdescribed with respect to FIG. 6B, is connected to the distal end of therod 902. Therefore, when the tube 901 drives along the rod 902, both therod 902 and the suturing needle 302 rotate in a first direction, whichallows the suturing needle 302 to deploy from the suture housing 301 andgrasp the fastener end 602. As the suturing needle 302 rotates andinserts the fastener end 602 into the anchor end 603, the protrusions903 have traveled the complete length of the grooves 904 of the tube901, and the rod 901 ceases rotational movement. When the force iswithdrawn from the proximal end of the tube 901, the fastener end 602remains locked in the anchor end 603, and the tube 901 reversesdirection causing both the rod 902 and the suturing needle 302 to rotatein a second direction until the protrusions 903 travel the length of thegrooves 904 in the opposite direction, retracting the suturing needle302 into the suture housing 301. As the suturing needle 302 retractsback in to the suture housing 301, the arm 710 of the suturing needle302 will push down on the anchor end 603, allowing the entire suture torelease from the device.

In one implementation, the hub 905 of the tube 901 can be coupled to amanual trigger. A trigger, as described with respect to FIG. 4, mayapply a force to the hub 905 of the tube 901, engaging the drive system900. The trigger is connected to the proximal end of a manual arm. Themanual arm can be the laparoscope. The drive system 900 can be connectedto the distal end of the stem of the laparoscope. Upon the surgeonsqueezing the trigger, the tube 901 is propelled forward along the rod902, resulting in both the rod 902 and the suturing needle 302 rotatingin a first direction. Once the trigger is released, the tube 901reverses direction, causing both the rod 902 and the suturing needle 302to rotate in a second direction until the protrusions 903 travel thelength of the grooves 904 in the opposite direction, retracting thesuturing needle 302 into the suture housing 301.

In another implementation, the hub 905 of the tube 901 can be coupled toa robotic arm or incorporated as a robotic arm as part of arobotic-assisted surgical system. A robotic-assisted surgical systemforceps arm, may apply a force to the hub 905 of the tube 901, engagingthe drive system 900. The robotic-assisted surgical forceps arm isattached to a main hub of the robotic-assisted surgical system at itsproximal end, and includes forceps at its distal end. The main hub ofthe robotic-assisted surgical system contains one or more robotic armsthat the surgeon can control from a distance at a console. A sheath madeof a non-ridged sterile material may be used to connect the proximal endof the suture housing 301 of the suturing device 300, to the distal endof the robotic arm.

Forceps may be positioned at the proximal end of the drive system 900. Ahinge may be inserted into the forceps of the robotic-assisted surgicalforceps arm. The hinge may include a spring tensioned to keep theforceps open at a certain angle when the hinge is inserted into theforceps. Upon closing the forceps, the hinge compresses and lengthensthe forceps. The lengthened forceps come into contact with the tube 901and apply a force to the tube 901 that propels the tube 901 forwardalong the rod 902, which causes the rod 902 and the suturing needle 302to rotate in the first direction. When the surgeon opens the forceps,the tube 901 reverses direction causing both the rod 902 and thesuturing needle 302 to rotate in a second direction until theprotrusions 903 travel the length of the grooves 904 in the oppositedirection, retracting the suturing needle 302 into the suture housing301.

FIG. 10 shows a side view of an alternative drive system in accordancewith an implementation of the invention. Referring to FIG. 10, drivesystem 1000 can be used to operate a suturing device. The drive system1000 includes a tube 1001 and a rod 1002. The diameter of the rod 1002is smaller than the diameter of the tube 1001. The tube 1001 may includeone or more protrusions 1003 positioned on the interior surface of thetube 1001 towards the proximal end. The rod 1002 may have one or moregrooves 1004 that extend in a spiral manner from a proximal end of therod 1002 towards the distal end of the rod 1002. Each groove 1004 cancorrespond to one of the one or more protrusions 1003. The one or moreprotrusions 1003 attached to the tube 1001 are configured to move alongthe one or more grooves 1004 within the rod 1002.

In one implementation, the proximal end of the tube 1001 may abut a hub1005, and the distal end of the tube 1001 is coupled to a rod 1002 of asuturing needle. The rod 1002 can have the hub 1005 positioned at theproximal end of the rod 1002. The hub 1005 is attached to the hubhandles 1006 which are configured to attach to a forceps or laparoscopicdevice. The tube 1001 is configured to remain fixed along a direction ofa rod axis of the rod 1002 while being able to rotate about the rodaxis. The rod 1002 is configured to remain fixed in a radial directionwhile being movable forward and backward along the rod axis.

In a starting position, the rod 1002 is positioned inside the tube 1001,where the protrusions 1003 lay on the grooves 1004 of the rod 1002 andthe hub 1005 of the rod 1002 meets the proximal end of the tube 1001. Asa force pushes on the hub 1005, the grooves 1004 engage the protrusions1003 of the tube 1001 and the rod 1002 drives along the tube 1001 fromthe proximal end of the tube 1001 to the distal end of the tube 1001,thereby rotating the tube 1001 forward as the protrusions 1003 travelalong the grooves 1004 of the rod 1002. Once the force is withdrawn fromthe proximal end of the rod 1002, the rod 1002 reverses direction fromthe distal end of the tube 1001 to the proximal end of the tube 1001,thereby rotating the tube 1001 backward as the protrusions 1003 travelalong the grooves 1004 in the opposite direction.

Suturing devices, needles, sutures, and drive systems are presentedherein.

According to some embodiments, a suture is provided comprising: afastener end; an anchor end; and a suture thread connected to andextending between the fastener end and the anchor end. The fastener endcan comprise a first and second conical shaped structure, the first andsecond conical shaped structure having a top and a bottom, the suturethread fixed to the top, the bottom being larger than the top. Theanchor end can comprise an anchor housing and a chamber, the interiorsurface of the chamber having a conical shape. The first conical shapedstructure can be configured to slide through the anchor housing andremain locked in the anchor end once the first conical shaped structureis inserted through the chamber of the anchor end. The second conicalshaped structure can be configured to be pulled through the chamber,wherein the pulling of the second conical shaped structure through thechamber tensions a suture to a predetermined tension level.

According to some embodiments, a suture magazine is provided comprising:a belt having one or more notches; at least one suture having a fastenerend, an anchor end, and a suture thread connected to and extendingbetween the fastener end and the anchor end, the anchor end positionedparallel to the fastener end, the fastener end releasably secured to thebelt; a crossbar having a first end and a second end, the first endfixed to the belt, the second end in contact with the anchor end; and aspring in tension with the second end of the crossbar, wherein thespring applies a pushing force to the anchor end, urging the beltforward once a fastener has been released. The fastener end can comprisea curved enclosure having a ridged surface, a top, and a bottom, thesuture thread fixed to the top, the bottom having a suture guide looppositioned laterally. The anchor end can comprise a rectangularenclosure and a chamber, the interior surface of the chamber having atleast one shoulder.

Any reference in this specification to “one implementation,” “animplementation,” “example implementation,” etc., means that a particularfeature, structure, or characteristic described in connection with theimplementation is included in at least one implementation of theinvention. The appearances of such phrases in various places in thespecification are not necessarily all referring to the sameimplementation. In addition, any elements or limitations of anyinvention or implementation thereof disclosed herein can be combinedwith any and/or all other elements or limitations (individually or inany combination) or any other invention or implementation thereofdiscloses herein, and all such combinations are contemplated with thescope of the invention without limitation thereto.

It should be understood that the examples and implementations describedherein are for illustrative purposes only and that various modificationsor changes in light thereof will be suggested to persons skilled in theart and are to be included within the spirit and purview of thisapplication.

What is claimed is:
 1. A suture magazine comprising: a set of sutures, each suture of the set of sutures comprising a fastener, an anchor, and a suture thread extending between the fastener and the anchor; a suture mover supporting the set of sutures between a first end and a second end of the suture magazine; and a biasing element coupled to the suture mover and biasing the set of sutures toward the first end of the suture magazine, the biasing element contributing to an advancing mode of the suture magazine wherein, in the advancing mode, a leading suture of the set of sutures is displaced from the first end of the suture magazine by a compressive force applied by at least one of the biasing element and the suture mover, wherein the leading suture of the set of sutures is exposed at the first end and aligned with a suture needle, wherein the suture magazine comprises: a first operation mode in which a piercing end of the suture needle is rotated in a first direction and engages the fastener of the leading suture to displace the fastener through a tissue and through the anchor, and a second operation mode in which the suture needle is rotated in a second direction opposite the first direction and engages the anchor of the leading suture to displace the anchor from the first end of the suture magazine.
 2. The suture magazine of claim 1, wherein the fastener of each suture of the set of sutures comprises a locking body with a grasping edge, the anchor of each suture of the set of sutures comprises an anchor housing with a chamber terminating at a locking surface, and wherein, for a respective suture of the set of sutures, the grasping edge of the locking body of the respective suture is configured to pass through the chamber of the anchor of the respective suture and be retained at the locking surface of the anchor end of the respective suture.
 3. The suture magazine of claim 2, wherein the fastener of each suture of the set of sutures comprises a cavity configured to allow compression of the fastener as it passes through the chamber of the anchor of the respective suture, and wherein the grasping edge of the fastener extends laterally from the suture thread of the respective suture.
 4. The suture magazine of claim 2, wherein the respective suture further comprises a tensioning body positioned at a location along the suture thread between the fastener and the anchor of the respective suture, wherein, in a sutured mode, the location defines a predetermined tension when at least one of the tensioning body and the fastener passes through tissue and through the anchor of the respective suture.
 5. The suture magazine of claim 1, wherein the suture mover defines a set of parallel tracks supporting the set of sutures in a serial arrangement.
 6. The suture magazine of claim 5, wherein the biasing element is positioned toward the second end of the suture magazine, behind the suture mover.
 7. The suture magazine of claim 5, wherein the biasing element comprises at least one of a spring and an elastic member behind the suture mover.
 8. The suture magazine of claim 1, wherein in coordination with the second operation mode, the biasing element advances at least a portion of the suture mover toward the first end, thereby advancing remaining sutures of the set of sutures toward the first end.
 9. The suture magazine of claim 8, wherein the biasing element comprises a spring coupled to the portion of the suture mover configured to advance remaining sutures of the set of sutures toward the first end.
 10. The suture magazine of claim 1, wherein the suture mover comprises at least one notch that secures the fasteners of remaining sutures of the set of sutures in position.
 11. The suture magazine of claim 1, wherein the suture magazine is configured to be released from a medical device housing and disposed. 